Why we need “Death Panels”

The “vast right-wing conspiracy” is trying to scare people into opposing health care reform by distorting the issues. Those wingnuts, most famously Sarah Palin, are promoting the idea that President Obama is trying to create government “death panels” that will cut off your medical payments and force you to die, just to save money.

The spin here is dizzying. Obama has not made any concrete reform proposals. He’s trying to stay above the discussion for now. There is a proposal in a House plan that would allow coverage for patients who discuss end-of-life options in advance with their doctors. Since the wingnuts have nothing to contribute themselves and Obama is giving them nothing to attack, they twisted this House proposal into “mandatory Obama death panels”.

The supply of health care money is not infinite, so decisions have to be made. This is not a bad thing, if patients and their families get the help they need to contribute to the decisions. Without the information in a typical “death panel” discussion, patients can’t make informed decisions, families may ask for ineffective but expensive care out of guilt or an inability to let go, and doctors may recommend treatment options that have no chance of curing the patient to avoid accusations that they didn’t do everything possible. Sometimes these choices do nothing other than prolong a life of agony.

End-of-life care is an important part of the medical care budget. A look at Medicare, the government program that provides health care for older Americans, shows that 30% of Medicare’s annual costs are spent on the 5% of beneficiaries who will die in a given year. About one-third of the dollars spent in the last year of life are spent in the last month. Researchers found that if only 50 percent of people discussed end-of-life care with their physician, the savings could be more than $76 million a year.

In a study of terminal cancer patients at the Dana-Farber Cancer Institute in Boston, those who had end-of-life conversations spent about one-third less in their last week than those who didn’t. Those who didn’t talk about options had more aggressive treatment, like ending up on ventilators in intensive care or receiving resuscitation. These patients had an inferior quality of death by any measure, they left their families in more emotional and financial distress, and in the end they didn’t live any longer.

These aren’t “death panels”. Federal law actually bars Medicare from paying for services “the purpose of which is to cause, or assist in causing,” suicide, euthanasia or mercy killing. Euthanasia is not part of the health care reform discussion, no matter how hard the wingnuts try to make you think it is.